Nerve Transfer
Conditions
Keywords
Nerve transfer
Brief summary
Measurement of clinical outcome after nerve transfer in deficiency of shoulder external rotation in children with OBPP.
Detailed description
Brachial plexus birth injuries (BPBI) occur in 1-2 per 1,000 live births, often resulting from traction on the shoulder during delivery (1). Right-sided injuries are more common due to fetal positioning.(2) BPBI presentations vary, with upper trunk injuries (Erb's palsy) being most frequent, accounting for 45% of cases.(3) These injuries can impair shoulder abduction, external rotation, and arm function ,He can't flex the elbow to partially reache the hand to the mouth (the trumpet sign) .due to suprascapular nerve (SSN) damage, which is prone to stretching due to its fixed attachments.(4) Erb's palsy affects muscles like the deltoid and biceps, supraspinatus and infraspinatus.(5) . Assessments include testing hand sensation and noting color or trophic changes. Without SSN reconstruction, secondary glenohumeral complications often arise, necessitating surgical interventions like tendon transfers, joint reductions, or osteotomies.(6) Nerve transfer, such as spinal accessory nerve (SAN) fascicles to the SSN, has shown superior outcomes for restoring shoulder function. The SAN, a pure motor nerve, is well-suited for direct coaptation without interposition grafts.(7). Surgical approaches include anterior and posterior methods, each with unique benefits. For instance, the anterior approach allows simultaneous brachial plexus exploration and facilitates nerve repair.(8) , while posterior approach prevents double crush phenomenon.(9) Despite most children recovering spontaneously, 20-30% experience residual deficits (10). Techniques like tension-free SAN-to-SSN repair aim to improve outcomes. This study evaluates the efficacy of SAN transfers in restoring shoulder stability, abduction, and external rotation in BPBI patients.(11)
Interventions
PROCEDURENeurotization of Spinal Accessory Nerve To Supra-Scapular in children with OBPP with deficiency of Shoulder External Rotation
Neurotization of Spinal Accessory Nerve To Supra-Scapular Nerve in children with OBPP presented with deficiency of Shoulder External Rotation.
PROCEDURENeurotization of Spinal Accessory Nerve To Supra-Scapular Nerve
Just to assess clinical outcomes after Neurotization of spinal accessory nerve to Supra-Scapular Nerve in patients with deficiency of Shoulder External Rotation
Sponsors
Assiut University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Measurement of clinical outcome of Reanimation Of Shoulder External Rotation In Children With Obestetric Brachial Plexus Palsy Through Neurotization Of Spinal Accessory Nerve To Supra- Scapular Nerve.
Eligibility
Sex/Gender
ALL
Age
1 Years to 3 Years
Healthy volunteers
No
Inclusion criteria
* children within 1.5 - 3 years . * No previous surgery * full passive ROM * presented with Trumpet sign
Exclusion criteria
* age \<1.5 - \>3 years * previous surgery in the shoulder * Stiff shoulder. * total OBPP * traumatic BPI * follow up \<1 year.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Neurotization in OBPP | Baseline | Improvement in Shoulder External Rotation after neurotization, and Functional Outcome Scores using mallet score Measurement of the clinical outcome of Active shoulder external rotation following Spinal accessory nerve to supra scapular Nerve transfer in children with Obstetric brachial plexus palsy, , * follow up one year or more , or Recovery of active ER . * based on:- * 1-------- mallet score from 1 to 5:--- (12) 1\. Flail shoulder 2. Zero degree external rotation 3. Active ER up to 20 degrees 4. Active ER over than 20 degrees 5. Normal shoulder * 2----Gilbert shoulder score :- for shoulder ROM and strength (13) 0- complete flail shoulder( none) 1. no active ER , Abduction to 45° ( poor) 2. neutral ER , Abduction\<90(fair) 3. weak ER , Abduction= 90°( satisfactory) 4. incomplete ER, Abduction\<120°( good ) 5. active ER , Abduction\> 120°( excellent) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Measurement of ROM after Neurotization | Baseline | Asses the recovery of shoulder stability and overall. Shoulder Range of Motion (ROM): |
Contacts
Primary ContactAhmed Faraag Abu el wafa Sayed, Primary investigator
Backup ContactAmr El sayed Ali Ibrahim, Professor
Outcome results
None listed